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Rough diamonds into gemstones


									                                       Periodontal Therapy

Rough diamonds into gemstones
   I live in a small Southern town, and I do my bank-          told me, in no uncertain terms, that she was tired of work-
ing at a small community bank. When I pulled into the          ing for dentists who would not invest in her, meaning that
bank parking lot every other week, I would wave to, and        she wasn’t using state-of-the-art dental hygiene equip-
sometimes visit, an old woman who, for years, stood on a       ment and technologies, and she was tired of working with-
corner directly across the street. She was a throat cancer     out what she felt she needed to perform her duties to the
victim and was very thin and frail looking, with a notice-     best of her ability.
ably weathered face. She would stand against a pole in the         Colleen purchased loupes first and then purchased her
same spot all day long — rain or shine — and wait for          favorite piezo ultrasonic unit next. Colleen told me some-
a passerby to give her a dollar or two after leaving the       thing else that really stuck with me, and it relates to other
bank. During the hot summer months, the sun would beat         hygienists who are also interested in investing in them-
down on her wrinkled face, and yet she seemed perfectly        selves. A hygienist approached Colleen at a recent public
                             content. Sometimes, I sat in      speaking engagement and told Colleen that she wanted to
                             the parking lot for a few mo-     hire her so that she could better herself and become more
                             ments and watched the cars        marketable.
There are many               go by, and I often wondered           Now that’s a 180-degree turn if ever I’ve seen one!
jewels among us why some people stopped and                    Usually, the hygienist relies on the dentist for continuing
who can assist               fussed over her while others      education expenses and other advanced training, and there
                             just passed her by — possi-       are many dental hygiene clinicians who won’t take the ini-
those who wish to bly regarding her as a bit of                tiative to better themselves. Colleen often refers to herself
challenge and                an embarrassment. When she        as a “diamond in the rough” that, I believe, now shines like
                             died recently, I didn’t have to   a stunning, multifaceted jewel.
re-invent                    read the local newspaper to           Hygienists who are committed and passionate about
themselves.                  find out. The spot where she       periodontal therapy are very different from the “chat and
                             used to stand for hours on end    polish” model. These practitioners devour the research
                             was filled with farewell mes-      literature and love to try new techniques, equipment, and
sages and bouquets of flowers. It was a very moving sight.      technologies. They value the services they deliver to their
   When I think about dental hygiene practitioners, I of-      clients and don’t hesitate to schedule adequate time for
ten scratch my head and wonder why some are “chat and          oral hygiene instruction or a comprehensive periodontal
polish” hygienists who just go through the motions day         examination. Dedicated practitioners work only in prac-
after day (like car drivers who repeatedly passed the old      tices in which they are respected and acknowledged, and
woman without stopping or waving) and others are in-           ones in which they can grow professionally and treat cli-
credibly driven, compassionate, and professional.              ents comprehensively.
   Take, for example, Colleen Rutledge, RDH. Colleen
and I first met last year when I joined a speaking and con-     Lynne H. Slim, RDH, BSDH, MSDH, is a practicing
sulting network of which Colleen was already a member.         hygienist/periodontal therapist who has more than 20 years
Colleen is a periodontal therapist who is the epitome of       experience in both clinical and educational settings. She is also
a dedicated professional. As a dental practice consultant,     President of Perio C Dent Inc. (Perio-Centered Dentistry), a
public speaker, and practicing periodontal therapist, Col-     practice management consulting firm that specializes in creating
leen exudes a positive karma. She has a natural ability to     outstanding dental hygiene teams. Lynne is a member of the
arouse enthusiasm among hygienists, and she understands        Speaking and Consulting Network (SCN) that was founded by
what it means to be self-empowered.                            Linda Miles and has won two first place journalism awards from
                                                               ADHA. Lynne is also owner/moderator of a periodontal therapist
   I asked her recently to tell me what led her to become
                                                               yahoo group:
passionate about nonsurgical periodontal therapies. She                                                                                                             May 2005/RDH • 33
                                           Periodontal Therapy
    What do these professionals know about periodontal         appreciates your value.
diseases that leaves the “chat and polish” hygienists in the       ■ Complex biofilm is enemy No. 1, and it proceeds
dust? Advanced dental hygiene practitioners who special-       from a gram-positive streptococcus-rich biofilm to a
ize in periodontal therapy understand that:                    structure rich in gram-negative anaerobes. The mi-
    ■ Clients must be susceptible to disease. This             croflora that repopulate pockets after debridement may
means that these individuals frequently present with mul-      be the result of the maturation of supragingival plaque
tiple etiologies like genetic predisposition, host anatomy,    or incomplete removal of subgingival biofilm. Scientific
occlusion, and inflammatory response. Susceptibility is of-     evidence for the role of calculus in the initiation and pro-
ten modified by local factors like occlusal trauma, systemic    gression of periodontitis is inconclusive. Calculus might
factors such as diabetes, or some other immunocompro-          act as a reservoir for biofilm or its presence subgingivally
mised condition. There are also behavioral factors like        could possibly trigger an inflammatory response with sub-
stress that play a significant role in disease pathogenesis.    sequent infection in susceptible people. Microbiologists
It’s no longer good enough to think in terms of “bacterial     theorize that subgingival calculus helps to strengthen the
load” as being the only etiologic factor.                      biofilm by interlocking it with the calculus, which creates
    ■ Clients need to manage their own disease. Once           a more secure matrix that is inpenetraable by irrigation
your clients understand that they have a disease of the        and local anti-infective agents.¹
“bone,” you can gently lead your clients to a new level of         ■ Clients who maintain a high standard of self-
guided discovery. Instead of the traditional instructor-ori-   performed plaque/biofilm control along with routine
ented approach, teach your clients that they can become        continuing care can effectively control a majority of
managers of their own susceptibility.                          gingival and periodontal diseases. An impressive review
    For example, Sandy Sheffler is a practicing hygienist       of the long-term effects of a 30-year biofilm/plaque control
who likes to perform phase-contrast microscopy so that         program for over 500 clients in one private practice set-
her clients can visualize the microscopic changes that take    ting revealed that a dentist/hygienist team can effectively
place before and after debridement. Slide samples also al-     maintain clinical attachment levels and even improve at-
low clients to play a more active role in managing their       tachment levels interproximally in many patients.²
microbial load. In a way, she’s like a broker who transfers        ■ Effective nonsurgical therapy reduces the need
ownership of an active disease state to the patient. Guided    for surgery for many patients but enhances the value
discovery works beautifully if you ask the right questions     of surgery for others. In cases in which nonsurgical ther-
and invite clients to think and personalize the disease.       apy fails to achieve the desired clinical outcome, regen-
    By asking your clients the right questions, you transfer   erative surgery (guided tissue regeneration and/or bone
ownership of the disease to them. Here’s another example       grafts) may be needed to repair the damage that resulted
to make this important distinction between instructor-         from periodontal disease.
oriented and guided discovery a bit clearer. Let’s say that        ■ The oral cavity is a portal of entry by which
you have already viewed the client’s full mouth series of      pathogenic bacteria can gain access to the circulatory
radiographs and there is obvious radiographic evidence of      system. In other words, “gum bugs” in infected tissues can
grade II and III furcation involvement in the mandibular       hitch a ride to other parts of the body through circulat-
molar region. Show the client what furcation involvement       ing blood. These bugs that escape can possibly cause dis-
looks like and include images that reflect different furca-     ease in other parts of the body in a susceptible host. Many
tion grades. Next, ask the client to study his mandibular      dental hygiene practitioners are excited about developing
molar radiographs with you and ask him to grade the fur-       collaborative, interdisciplinary relationships with other
cations while you record them. A powerful way to get the       health-care professionals, and these joint arrangements
point across would be to place a plasma screen directly in     are welcomed by the dental hygiene and other health-care
front of the client so that you could manipulate various       communities.
radiographic digital images on the TV screen.                      Over time, I have begun to think of the dental hygiene
     ■ It is standard practice to spend adequate time          community as an inner family that helps each member
with clients, and the resulting fees must reflect the           build upon his or her strengths. There are many jewels
comprehensiveness of care rendered. How many times             among us who can assist those who wish to challenge and
are we guilty of giving away services? A periodontist re-      re-invent themselves. Find a mentor who can impact your
cently told me that his patients did not value home-care       career development and personal growth, re-directing
instruction until he started charging for the service.         your energy. You, too, can become a stunning gem and go
    As frustrating as it might be for patients to come back    far beyond a “diamond in the rough.”
several times for oral hygiene instruction or for debride-     References
ment procedures, understand that there is no quick fix for      1 Conversation that took place at the Hinman Dental Convention in Atlanta on March 19, 2005,
                                                               with with Jim Chandler, president of Vista Research Group in Ashland, Ohio.
periodontitis. Recognize the value of the services you pro-    2 Axelsson P et al. The long-term effect of a plaque control program on tooth mortality, caries
vide and work in a practice where your dentist-employer        and periodontal disease in adults. J Clin Periodontol 2004; 31: 749-757

34 • RDH/May 2005                                                                                                       

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